Limitations of successive transradial approach in the same arm: The Japanese experience

Sakai, Hideaki; Ikeda, Satoshi; Harada, Takashi; Yonashiro, Suguru; Ozumi, Kiyoshi; Ohe, Haruto; Ochiai, Masahiko; Miyahara, Yoshiyuki; Kohno, Shigeru

doi:10.1002/ccd.1268

Cited by 100 publications

(56 citation statements)

References 16 publications

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“…Radial artery occlusion after transradial coronary angiography and intervention has been reported to occur in 2 to 10% of patients 4,9,15,22,23) . The explanation for why some patients develop occlusion is unknown.…”

Section: Discussionmentioning

confidence: 99%

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience

Park

Kim

et al. 2010

J Korean Neurosurg Soc

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Objective : Although a transradial angiography is accepted as the gold standard for cardiovascular procedures, cerebral angiography has been performed via transfemoral approach in most institutions. The purpose of this study is to present our experience concerning the feasibility, efficacy, and safety of a transradial approach to cerebral angiography as an alternative to a transfemoral approach. Methods : Between February 2007 and October 2009, a total of 1,240 cerebral angiographies were performed via a transradial approach in a single center. The right radial approach was used as an initial access route. The procedure continued only after the ulnar artery was proven to provide satisfactory collateral perfusion according to two tests (a modified Allen's test and forearm angiography). Results : The procedural success rate was 94.8% with a mean duration of 28 minutes. All supra-aortic vessels were successfully catheterized with a success rate of 100%. The success rates of selective catheterization to the right vertebral artery, right internal carotid artery, left internal carotid artery, and left vertebral artery were 96.1%, 98.6%, 82.6% and 52.2%, respectively. The procedure was performed more than twice in 73 patients (5.9%), including up to 4 times in 2 patients. The radial artery occlusion was found in 4 patients (5.4%) on follow-up cerebral angiography, but no ischemic symptoms were observed in any of the cases. Conclusion : This study suggests that cerebral angiography using a transradial approach can be performed with minimal risk of morbidity. In particular, this procedure might be useful for follow-up angiographies and place less stress on patients.

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Section: Discussionmentioning

confidence: 99%

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience

Park

Kim

et al. 2010

J Korean Neurosurg Soc

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“…Sakai et al 33 studied patients undergoing repeated transradial interventions in the same arm and found that the rate of radial access site failure increased with successive procedures. This appears to be due to progressive narrowing of the artery with each procedure, rendering it more difficult to cannulate.…”

Section: Pathophysiologymentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

176

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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“…Post-surgical recommendations include taking spasmolytic medication namely isosorbide dinitrate. Importantly, 2 to 10% of patients may face complications after transradial coronary angiography due to radial artery occlusion so it should be taken seriously [14,[23][24][25][26] as prolonged cannulation, the small diameter of the radial artery, the ratio of the radial artery diameter to the sheath outer diameter, and to the anticoagulation used during arterial cannulation may be the potential causes [25,27,28]. In transradial cerebral angiography, if a navigation into the left ICA (difficult to catheterize in patients with high tortuosity) or left VA (difficult to capture) is required, a right transradial procedure may be more challenging.…”

Section: Discussionmentioning

confidence: 99%

Transradial Neurointerventional Approach to Basilar Tip Aneurysm: Case Report and Technical Note

Ghorbani

Hejazian

2017

IrJNS

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Cerebral angiography through transfemoral approach is preferred in most of the situations though in cardiovascular surgery transradial angiography is accounted as the superior standard. The present study aimed at presenting our early experience of transradial approach to cerebral angiography and intervention of a patient with basilar tip aneurysm that had inappropriate vasculature to perform routine transfemoral approach. The patient was a 65 year-old man with a large basilar tip aneurysm that was candidate for endosacular coiling through transfemoral route. But due to very tortuous iliac artery, aortic arch and its branches, navigation transfemorraly via both vertebral arteries was impossible. Therefore we decided to do the procedure through right transarterial route. The procedure was started by doing Allen`s test to confirm good perfusion of right hand by collateral arteries. After that cerebral angiography and neurointervention was done transradially without any complication. As a result, although a transradial approach is not a routine way for cerebral angiography and intervention, it can be used safely as an alternative way in specific cases.

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Limitations of successive transradial approach in the same arm: The Japanese experience

Cited by 100 publications

References 16 publications

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience

Is Transradial Cerebral Angiography Feasible and Safe? A Single Center's Experience

Radial Artery Patency After Transradial Catheterization

Transradial Neurointerventional Approach to Basilar Tip Aneurysm: Case Report and Technical Note

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